Treatments and drugs

Several treatments for hyperthyroidism exist. The best approach for you depends on your age, physical condition and the severity of your disorder:

Radioactive iodine. Taken by mouth, radioactive iodine is absorbed by your thyroid gland, where it causes the gland to shrink and symptoms to subside, usually within three to six months. Because this treatment causes thyroid activity to slow considerably, causing the thyroid gland to be underactive (hypothyroidism), you may eventually need to take medication every day to replace thyroxine. Used for more than 60 years to treat hyperthyroidism, radioactive iodine has been shown to be generally safe.

Anti-thyroid medications. These medications gradually reduce symptoms of hyperthyroidism by preventing your thyroid gland from producing excess amounts of hormones. They include propylthiouracil and methimazole (Tapazole). Symptoms usually begin to improve in six to 12 weeks, but treatment with anti-thyroid medications typically continues at least a year and often longer. For some people, this clears up the problem permanently, but other people may experience a relapse. Both drugs can cause serious liver damage, sometimes leading to death. Because propylthiouracil has caused far more cases of liver damage, it generally should be used only when you can't tolerate methimazole. A small number of people who are allergic to these drugs may develop skin rashes, hives, fever or joint pain. They also can make you more susceptible to infection.

Beta blockers. These drugs are commonly used to treat high blood pressure. They won't reduce your thyroid levels, but they can reduce a rapid heart rate and help prevent palpitations. For that reason, your doctor may prescribe them to help you feel better until your thyroid levels are closer to normal. Side effects may include fatigue, headache, upset stomach, constipation, diarrhea or dizziness.

Surgery (thyroidectomy). If you're pregnant or otherwise can't tolerate anti-thyroid drugs and don't want to or can't have radioactive iodine therapy, you may be a candidate for thyroid surgery, although this is an option in only a few cases.

In a thyroidectomy, your doctor removes most of your thyroid gland. Risks of this surgery include damage to your vocal cords and parathyroid glands — four tiny glands situated on the back of your thyroid gland that help control the level of calcium in your blood. In addition, you'll need lifelong treatment with levothyroxine (Levoxyl, Synthroid, others) to supply your body with normal amounts of thyroid hormone. If your parathyroid glands also are removed, you'll need medication to keep your blood-calcium levels normal.

Graves' ophthalmopathy

If Graves' disease affects your eyes (Graves' ophthalmopathy), you can manage mild signs and symptoms by avoiding wind and bright lights and using artificial tears and lubricating gels. If your symptoms are more severe, your doctor may recommend treatment with corticosteroids, such as prednisone, to reduce swelling behind your eyeballs. In some cases, a surgical procedure may be an option:

Orbital decompression surgery. In this surgery, your doctor removes the bone between your eye socket and your sinuses — the air spaces next to the eye socket. When the procedure is successful, it improves vision and provides room for your eyes to return to their normal position. But there is a risk of complications, including double vision that persists or appears after surgery.

Eye muscle surgery. Sometimes scar tissue from Graves' ophthalmopathy can cause one or more eye muscles to be too short. This pulls your eyes out of alignment, leading to double vision. Eye muscle surgery may help correct double vision by cutting the affected muscle from the eyeball and reattaching it farther back. The goal is to achieve single vision when you read and look straight ahead. In some cases, you may need more than one operation to attain these results.

Bahn RS, et al. Hyperthyroidism and other causes of thyrotoxicosis: Management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21:593.

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